So, yesterday,  we spoke about renal transplantation.  Kidneys are the most common transplanted organ.   But, what about livers?

Here’s a key fact.  When we donate a kidney, we lose one of the two we have.  (Of course, if it is a cadaver transplant [upon our death], that’s not such a big issue.) Many of us worry- especially given our obesity epidemic- that we will develop diabetes and/or high blood pressure- which means kidney failure is possible.  And, then, we’d only have one kidney!

But, when we transplant livers, we only donate a sliver (OK- a big sliver, about 50%) of the organ.  And, both our liver- and the portion we donate- grow back to full size.  It takes about 90 days post surgery for this to be complete- assuming we are otherwise healthy.  So, there’s less risk to us in donating a liver to someone who needs it.

In America, though, only about 1/20 (5%, or 401 of the 7500  effected each year) of liver transplants come from live donors.  Despite the fact that a live donor transplant provides much better odds for the recipient.

Bet you would be surprised to find that, despite the fact that our livers regenerate and our kidneys don’t, there are 15X as many live kidney transplants performed every year in the USA.  Yes, there were 6000 live donor kidney grafts last year.  (The reason is probably due to the fact that recovery time for the kidney donor is much shorter [liver donors stay in the hospital for about 6 days and miss work for at least 4 weeks; physical laborers need 10 weeks]- and the procedure is less intense. This involves major abdominal surgery- thankfully, only 6 folks have died while donating their livers- over the past 25 years!)

There are some 13K patients on the waiting list for a liver.  And, just like for kidneys, the wait can be a year or so before a viable candidate is found.  And, since there is no artificial liver- as opposed to an artificial kidney (really, dialysis is not a full replacement), 1/6 to ¼ of the waiting list dies before ever receiving a graft.  And, those that do make the transplant are a heck of a lot sicker when they finally get the transplant than when they were put on the list.  Which means the surgery is a lot trickier.

Drs. A Humar, S Ganesh, D Jorgenson, A Tevar, A Ganoza, M Molinari, and C Hughes (all from the University of Pittsburgh- one of the two massive health systems in the city) published a study in the Annals of Surgery recently.  They examined 245 living donor transplants and 592 cadaver transplants performed over a ten-year period (2009-2019).  The criteria examined were the three-year survival rates, the length of the hospital stay (11 v 13 d), and other criteria.  (Note that UPMC- the University of Pittsburgh Medical Center- performs some 15% (68) of all living liver transplants in the USA.)

 

The living donors had far better 3 year survival rates (86% versus 80%), didn’t need as much dialysis after the surgery, and were stuck in the hospital for shorter times.  And, the costs were almost 30% lower (the real number- 29.5%)- which in today’s environment is a strong factor.

Those that can donate livers should be between 18 and 55 y old and in good health.  Moreover, there are procedures to afford liver transplants between folks with different (non-matching) blood types.

So, maybe we can increase the number of live liver transplants in America?

 

 

So, you thought I wouldn’t mention it?   The 18th anniversary of the largest attack on American soil by a foreign government?   (The Civil War- by Americans against Americans created far greater havoc.)  May those who perished be remembered fondly.   May those first responders receive the help they deserve from a miserly GOP establishment.  They- and their brothers and sisters who perished- helped many folks navigate their way to safety.  They exemplify what is best among our police, fire, and emergency crews.